文章摘要
方晓明,刘 茗,张 倩,黄燕华,俞 丹,陈雪松.机化性肺炎患者的CT引导下经皮肺穿刺活检及其临床诊治分析[J].,2019,19(22):4335-4338
机化性肺炎患者的CT引导下经皮肺穿刺活检及其临床诊治分析
CT guided Percutaneous Lung Biopsy and Its Clinical Diagnosis and Treatment in Patients with Organizing Pneumonia
投稿时间:2019-04-05  修订日期:2019-04-30
DOI:10.13241/j.cnki.pmb.2019.22.029
中文关键词: 机化性肺炎  CT  经皮肺穿刺活检  糖皮质激素  临床诊治
英文关键词: Organizing pneumonia  CT  Percutaneous lung biopsy  Glucocorticoid  Clinical diagnosis and treatment
基金项目:江苏省六大人才高峰基金资助项目(WSN092);江苏省333高层次人才基金资助项目(BRA2016119)
作者单位E-mail
方晓明 南京医科大学附属常州第二人民医院呼吸与危重症医学科 江苏 常州 213000 fangxiaoming1369@sina.com 
刘 茗 南京医科大学附属常州第二人民医院呼吸与危重症医学科 江苏 常州 213000  
张 倩 南京医科大学附属常州第二人民医院呼吸与危重症医学科 江苏 常州 213000  
黄燕华 南京医科大学附属常州第二人民医院呼吸与危重症医学科 江苏 常州 213000  
俞 丹 南京医科大学附属常州第二人民医院呼吸与危重症医学科 江苏 常州 213000  
陈雪松 南京医科大学第一附属医院呼吸与危重症医学科 江苏 南京 210036  
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中文摘要:
      摘要 目的:探讨CT引导下经皮肺穿刺活检对机化性肺炎患者的诊断价值,并总结机化性肺炎的临床诊治经验。方法:回顾性分析2015年7月-2017年9月在南京医科大学附属常州第二人民医院住院行CT引导下经皮肺穿刺活检取得肺部病灶组织确诊为机化性肺炎的14例患者,所有患者行CT引导下经皮肺穿刺活检,总结机化性肺炎患者的临床诊治经验。结果:14例机化性肺炎患者平均年龄为59岁,平均起病时间为21天。主要临床症状以发热、咳嗽、咳痰为主。6例肺部听诊可闻及湿啰音。影像学检查主要表现为肺部斑片状不均匀密度增高影。所有患者初次就诊时均未首先诊断考虑机化性肺炎。所有患者入院后均行CT引导下经皮肺穿刺活检术,术后病理均确诊为机化性肺炎,术中3例出现少量气胸,4例出现少量出血,予吸氧止血等对症处理后好转。14例患者予糖皮质激素治疗后,主要临床症状改善,影像学检查均较前吸收好转。结论:对于持续性干咳、呼吸困难、发热病人,抗生素疗效差,影像学显示片状或块状影病灶,特别是游走性斑片阴影,需要高度警惕机化性肺炎。CT引导下经皮肺穿刺活检可作为明确机化性肺炎诊断的首选方法。机化性肺炎对糖皮质激素治疗敏感,可出现可逆性的好转,一旦确诊,建议及早使用糖皮质激素治疗。
英文摘要:
      ABSTRACT Objective: To explore the diagnostic value of CT guided percutaneous lung biopsy in patients with organizing pneumonia, and to summarize the clinical experience of diagnosis and treatment of organizing pneumonia. Methods: A retrospective analysis was made of 14 patients with pulmonary lesions diagnosed as organizing pneumonia who underwent CT guided percutaneous lung biopsy in Changzhou Second People's Hospital Affiliated to Nanjing Medical University from July 2015 to September 2017.All patients underwent CT guided percutaneous lung biopsy to summarize the clinical diagnosis and treatment experience of patients with organizing pneumonia. Results: The average age of 14 patients with organizing pneumonia was 59 years, and the average onset time was 21 days. The main clinical symptoms were fever, cough and expectoration. 6 cases of lung auscultation could hear moist rales. The main manifestations of imaging examination were patchy and uneven density enhancement of the lungs. organizing pneumonia was not first diagnosed in all patients. All patients underwent CT guided percutaneous lung biopsy after admission. Postoperative pathology confirmed the diagnosis of organizing pneumonia. During the operation, 3 patients had a small amount of pneumothorax and 4 patients had a small amount of hemorrhage and patients improved after symptomatic treatment such as oxygen inhalation and hemostasis. After treatment with glucocorticoid, the main clinical symptoms of 14 patients were improved, and the imaging examination was better than before. Conclusion: For patients with persistent dry cough, dyspnea and fever, antibiotics have poor efficacy, and the imaging findings of patchy or massive shadow lesions, especially the shadow of wandering patches, need to be highly vigilant against organizing pneumonia.Ct guided percutaneous lung biopsy can be the first choice for the diagnosis of organizing pneumonia. Systemic pneumonia is sensitive to glucocorticoid therapy, and reversible improvement may occur. Once diagnosed, early application of glucocorticoid therapy is recommended.
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